Treatment of Renovascular Hypertension by Transluminal Renal Artery Dilatation

Mahler, F; Krneta, A; Haertel, M

doi:10.7326/0003-4819-90-1-56

Cited by 66 publications

(6 citation statements)

References 7 publications

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“…In 1934, Goldblatt et al [6] demonstrated in animals that experimental RAS causes hypertension, and Mahler et al [7] reported the first case of renal artery dilation for treatment of renovascular hypertension in 1979. Today, the rationale for invasive treatment of RAS is based on various aspects: RAS is a progressive disease [4,8], that is associated with a substantially increased risk of mortality, increasing with the severity of the stenosis [9].…”

Section: Rationale For Revascularizationmentioning

confidence: 99%

Treating Renal Artery Stenosis

Schillinger

Minar

Ahmadi

2004

Herz

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Renal artery stenosis (RAS) leading to hypertension or ischemic nephropathy can be treated by endovascular revascularization using balloon angioplasty or stent implantation. Although high technical success rates > 95%, relatively low frequencies of complications and good long-term patency can be achieved, the indications for interventional treatment are a matter of ongoing debate. Curing hypertension by means of angioplasty rarely occurs, although the number of antihypertensive medication usually can be reduced after successful treatment. Targeting ischemic nephropathy, revascularization can stabilize or at least slow the decline of renal function. Nevertheless, angioplasty also bears the risk of inducing renal deterioration. Careful patient selection remains the most crucial point in renal interventions, however, current data are insufficient to give final recommendations on this issue. The present review focuses on the potential beneficial effects of renal artery PTA and stenting in patients with RAS.

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Section: Rationale For Revascularizationmentioning

confidence: 99%

Treating Renal Artery Stenosis

Schillinger

Minar

Ahmadi

2004

Herz

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“…Surgical revascularization techniques for RAS include endarterectomy, patch angioplasty, extra-anatomic bypass grafting, and aortorenal bypass grafting 8. Percutaneous revascularization of RAS with balloon angioplasty was first reported in the 1970s 9,10. Although angioplasty is often able to achieve initial success in restoring renal blood flow, it is associated with a high rate of restenosis 11.…”

Section: Introductionmentioning

confidence: 99%

RX Herculink Elite® renal stent system: a review of its use for the treatment of renal artery stenosis

Colyer¹

2012

MDER

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The management of renal artery stenosis (RAS) remains controversial. While some evidence suggests that treatment with stent placement is beneficial, randomized trials have failed to demonstrate a significant benefit. Ongoing clinical trials should help to better define the role for stenting of RAS while avoiding limitations seen with earlier trials. When it comes to stenting for RAS, several stents have been used; however, many stents which have been used previously and which are still being used are biliary stents that are used “off-label.” These stents have typically come onto the market through the 510(k) pathway. To date, a total of five stents have been approved by the United States Food and Drug Administration for use in the renal arteries. Of the five stents that have received approval, the Bridge™ Extra Support (Medtronic Cardio- Vascular, Santa Rosa, CA) and the Palmaz® (Cordis Corporation, Bridgewater, NJ) stents are no longer available. Currently, the Express® SD (Boston Scientific, Natick, MA), Formula™ (Cook Medical, Bloomington, IN), and Herculink Elite® (Abbott Vascular, Santa Clara, CA) stents are Food and Drug Administration approved and available for use. The Herculink Elite is the most recently approved of the renal stents, having received approval in late 2011. The Herculink Elite stent is the only cobalt chromium stent approved for use in the renal arteries. Although trial data are limited and direct comparisons among renal stents is not possible, the Herculink Elite stent has demonstrated good performance. Additionally, the design of the Herculink Elite offers some advantages that may translate into improved outcomes.

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“…The first renal artery balloon angioplasties were performed by Felix Mahler in Berne and Andreas Grüntzig in Zurich in 1977 [1, 2]. Until the beginning of the 1990's, balloon angioplasty was the only method of percutaneous treatment of renal artery stenosis (RAS) with satisfying acute and long‐term results for angioplasty of stenoses caused by fibromuscular dysplasia (FMD) and atherosclerotic RAS of the renal artery trunk with procedural success rates of 82 to 100% and restenosis rates of about 10% [3–7].…”

Section: Introductionmentioning

confidence: 99%

Critical review of indications for renal artery stenting: Do randomized trials give the answer?

Schwarzwälder

Zeller

2009

Cathet Cardio Intervent

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Significant renal artery stenosis (RAS) is a well accepted cause of deterioration of arterial hypertension and of renal insufficiency. Just recently, more interest has been focused on the impact of RAS on structural heart disease and patient survival. Technical improvements of diagnostic and interventional endovascular tools have lead to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy during the past 2 decades. Since the first renal artery angioplasties performed by Felix Mahler and Andreas Grüntzig, numerous single centre studies have reported the beneficial effect of percutaneous transluminal renal angioplasty, and since the early 1990's stenting of renal artery stenosis caused either by atherosclerosis or fibromuscular dysplasia. However, none of the so far published or presented randomized controlled trials (RCT) could prove a beneficial outcome of RAS revascularization compared with medical management. As a result of these negative trials including the recently presented ASTRAL trial, referrals to endovascular renal artery revascularization went down and moreover, reimbursement of these procedures became a matter of debate. This article summarizes the background and the limitations of the so far published and still ongoing controlled trials. Moreover, we discuss why well-designed registries might give important insight on the impact of endovascular revascularization of hemodynamically relevant atherosclerotic RAS.

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Treatment of Renovascular Hypertension by Transluminal Renal Artery Dilatation

Cited by 66 publications

References 7 publications

Treating Renal Artery Stenosis

Treating Renal Artery Stenosis

RX Herculink Elite® renal stent system: a review of its use for the treatment of renal artery stenosis

Critical review of indications for renal artery stenting: Do randomized trials give the answer?

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Treatment of Renovascular Hypertension by Transluminal Renal Artery Dilatation

Cited by 66 publications

References 7 publications

Treating Renal Artery Stenosis

Treating Renal Artery Stenosis

RX Herculink Elite&reg; renal stent system: a review of its use for the treatment of renal artery stenosis

Critical review of indications for renal artery stenting: Do randomized trials give the answer?

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Product

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RX Herculink Elite® renal stent system: a review of its use for the treatment of renal artery stenosis